1. ¹Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA
2. ²Department of Nursing, University of Tennessee Health Science Center, Memphis, TN, USA
3. ³Department of Preventative Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
4. ⁴Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA

Correspondence: Dr Pedro Velasquez-Mieyer, Department of Pediatrics, LeBonheur Children's Medical Center, 50 North Dunlap, Memphis, TN 38103, USA. E-mail: pvelasquez@utmem.edu

^†Present address: Dept Epidemiology and Public Health, University of Miami, FL 33136, USA

^††Present address: U.S. Bariatric, Fort Lavderdale, FL 33308, USA

^†††Present address: Department of Pediatrics, University of California, San Francisco, CA 94143, USA.

Received 26 April 2002; Revised 5 August 2002; Accepted 7 October 2002.

Abstract

PURPOSE: Hyperinsulinemia is a common feature of many obesity syndromes. We investigated whether suppression of insulin secretion, without dietary or exercise intervention, could promote weight loss and alter food intake and preference in obese adults.

METHODS: Suppression of insulin secretion was achieved using octreotide-LAR 40 mg IM q28d for 24 weeks in 44 severely obese adults (89% female, 39% minority). Oral glucose tolerance testing was performed before and after treatment, indices of -cell activity (CIRgp), insulin sensitivity (CISI), and clearance (CP/I AUC) were computed, and leptin levels, 3-day food records and carbohydrate-craving measurements were obtained. DEXA evaluations were performed pre- and post-therapy in an evaluable subgroup.

RESULTS: For the entire cohort, significant insulin suppression was achieved with simultaneous improvements in insulin sensitivity, weight loss, and body mass index (BMI). Leptin, fat mass, total caloric intake, and carbohydrate craving significantly decreased. When grouped by BMI response, high responders (HR; BMI<-3 kg/m²) and low responders (LR; BMI between -3 and -0.5) exhibited higher suppression of CIRgp and IAUC than nonresponders (NR; BMI-0.5). CISI improved and significant declines in leptin and fat mass occurred only in HR and LR. Conversely, both leptin and fat mass increased in NR. Carbohydrate intake was markedly suppressed in HR only, while carbohydrate-craving scores decreased in HR and LR. For the entire cohort, BMI correlated with CISI, fat mass, and leptin. Fat mass also correlated with IAUC and CISI.

CONCLUSIONS: In a subcohort of obese adults, suppression of insulin secretion was associated with loss of body weight and fat mass and with concomitant modulation of caloric intake and macronutrient preference.